NHS vs US

September 15, 2009 by BlueGenes

It's been a month since the clamour and bustle about healthcare reform during the US Congress' summer break in August. The British blogosphere was then alight with spirited defenses of the NHS, like this piece from David Colquhoun. As Congress gets back to work, Obama is countering his critics with speeches on several of his main policy areas. Now that the dust has settled, I'd like to take a closer look at it. Please let us know what you think in the comments, either here on ScienceBlog or at Blue-Genes.net, where a spirited discussion has already started.

Firstly, it's worth noting that the NHS is incredibly popular as an instution. People love the NHS, although they often criticise government decisions made about it.

What is bemusing to us in the UK medical field is the way in which the NHS has been held to be an example of

1) An inefficient system

2) An unfair system that restricts access to treatments

3) Socialist or communist

4) The fate that could befall the US if healthcare reforms are passed

None of these are true. Before discussing the merits and drawbacks of the NHS, let's take point 4 - the US has an insurance-based system and it will in all likelihood remain that way. As Atul Gawande points out in this excellent New Yorker article the healthcare system is like the phone system: you can't just turn it off for a few months to replace it with something better. Health insurance systems developed naturally at first, with a varying course depending on local context, but now that they are in place they are very difficult and expensive to change by whatever means. It is therefore both highly improbable and probably undesirable for the US system to become like the NHS.

Many valid criticisms can be made of the NHS. As such, it is strange that its US critics have often strayed so far from reality in order to criticise it. The advantages of the NHS of 2009 are simple: free treatment for all with relatively short waiting times and good health outcomes, at a modest national cost of 8% of GDP per capita. Its disadvantages are: patchy funding depending on region for high-tech treatments that have a poor cost-effectiveness or are purely elective (the 'postcode lottery'), wards with little privacy, and high rates of hospital-acquired infection.

It is pretty efficient, then, and fair to all - since we all get charged the same - nothing (although there is regional variation in service provision, as mentioned above). Although it may have been founded on socialist principles, no-one in the UK ever calls the NHS 'socialist' or 'socialised', it is simply not considered as such. And in any case, unlike in the States, most countries in Europe call their mainstream left-wing politicians Socialists, who are considering far milder than Communists (which many in the US seem to consider identical). The NHS co-exists with private insurers, who are still able to sell premium services despite competing with an excellent government-run system. This should have been one of concrete factual argument used by the Democrats for the feasibility of a public option, rather than the counter-argument it became in a fact-free environment.

Then of course, there were the inevitable hilarious ideas such as "Stephen Hawking wouldn't have been allowed to live under the NHS" when he in fact says he owes his life to it.

By contrast, the US system costs an exorbitant 16% GDP per capita, does not cover a large fraction of the population, and has very little in the way of measures guaranteeing fairness. Half of that 16% is already spent on Medicare and Medicaid - so actually, Americans are spending proportionally just as many of their tax dollars on national healthcare programs as we are already, and see how much more we do with it. So to counter the fears of 'rationing', we actually provide more care to more people at the same cost.

It's a shame that truly intelligent discussion of healthcare has been derailed by scaremongering and one-liners in the US. While we could accuse anti-reform adovcates of disingenuousness, it's also clear that the Democrats failed to make a clear riposte to their arguments and a convincing case of their own. Intelligent and informed analysis pieces, such as this FT column, have been few and far between.